CDC Sets Sights on Better Tracking of U.S. Mental Health

Oct 5, 2011, 8:59 PM, Posted by NewPublicHealth

Reeves Dr. William Reeves, Centers for Disease Control and Prevention

How prevalent is mental illness in the U.S. adult population? You might be surprised. Recently the Centers for Disease Control and Prevention released a mental health surveillance report – the result of CDC's first agency-wide compilation of data that measure of mental illness in the U.S. The report authors found that a staggering 25 percent of U.S. adults have a mental illness. CDC is continuing to research and disseminate these findings both because mental illness is an important public health problem in itself but also because mental illness is associated with chronic diseases such as heart disease, diabetes and obesity.

And CDC has additional reasons for vigilantly monitoring mental health in the U.S.:

  • Mental illness is associated with lower use of medical care, reduced adherence to treatment for chronic diseases, and higher risks of adverse outcomes
  • Mental illness is associated with use of tobacco and abuse of alcohol
  • Assessing the need for mental and behavioral health services by location can lead to more appropriate allocations and increase access to care

NewPublicHealth recently spoke with William Reeves, M.D., and M.D. Senior Advisor for Mental Health Surveillance at CDC about the new report.

NewPublicHealth: Did the numbers in the report surprise you?

Dr. Reeves: Those numbers get your attention. But it does not give the whole picture. A problem with current surveillance is that the only diagnosable mental illness that is measured is depression. From various databases we know that about 7% of Americans are seriously depressed, and probably about 11% have an anxiety disorder.

But what is important is not just the fact that 7% of the population is depressed but what that depression does to their quality of life and the associations of depression and other mental illnesses with chronic medical conditions. You have had a heart attack; you’ve got chronic cardiovascular disease -- those are risk factors for developing depression. And adult-onset diabetes and obesity are in themselves risk factors for depression and for anxiety disorders. They share a common pathophysiology. That’s what’s really important about the prevalence and the occurrence of mental illness – their associations overall with wellness and unwellness in the other diseases.

NPH: How is the health community set up to address these issues with their patients?

Dr. Reeves: That’s really the pivotal question. What we had hoped to do in the report, and the coverage has been pretty good, is to get this to the attention of those people who are caregivers. You know, most mental illness in the U.S. is taken care of by primary care physicians because those are the ones that see the patients.

For the practitioner and the provider what is important is local data. A strength and a limitation is that most of the systems that monitor mental health in the U.S. are national in scope. So they tell me that 7% of the U.S. population has depression. That does not help me a lot if I am a provider in Knoxville, Tennessee. The Behavioral Risk Factor Surveillance Survey [BRFSS] provides state- and county-level estimates, and what it showed is that depression, high psychosocial unwellness or serious psychological conditions are more common in the southeastern states. And so, if we’re going to be providing messages, it is particularly important that those messages reach the providers in the southeastern states, for example. It’s very important that the providers who are taking care of people with many chronic conditions should be thinking about mental illness in those patients, and perhaps refer them as well.

NPH: What happens next?

Dr. Reeves: We identified weaknesses in the surveillance system, the fact that none of them measure anxiety disorders and CDC is currently in the midst of a survey in the Gulf Coast population that was affected by the Deep Water Horizon spill, and this is a survey specifically designed to measure most of the depths of mental health. It will, of course, answer some questions around Deep Water Horizon, but is also a chance to put in the type of survey that analysis of the current data shows is necessary. And next year CDC is going to be doing a similar report on mental illness in children.

Also, we had a goal with the report of driving people to the databases. All of the databases that are in the report are made available by CDC online to anyone who might want to go in and analyze them in more detail. We’re doing an analytic project to see what effect publication of this and the various things that are coming out in the media have had on utilization of the various websites and databases that are mentioned in the report. We’ll be able to see not only how much of the data is accessed and used but what specific [data] are being accessed and where in the country people are who are using the report and the associated information. Then perhaps we’d do more outreach in areas who are utilizing the data less to help disseminate this information as widely as possible.

This commentary originally appeared on the RWJF New Public Health blog.